tailieunhanh - Chapter 077. Approach to the Patient with Cancer (Part 12)

Death and Dying The most common causes of death in patients with cancer are infection (leading to circulatory failure), respiratory failure, hepatic failure, and renal failure. Intestinal blockage may lead to inanition and starvation. Central nervous system disease may lead to seizures, coma, and central hypoventilation. About 70% of patients develop dyspnea preterminally. However, many months usually pass between the diagnosis of cancer and the occurrence of these complications, and during this period the patient is severely affected by the possibility of death. . | Chapter 077. Approach to the Patient with Cancer Part 12 Death and Dying The most common causes of death in patients with cancer are infection leading to circulatory failure respiratory failure hepatic failure and renal failure. Intestinal blockage may lead to inanition and starvation. Central nervous system disease may lead to seizures coma and central hypoventilation. About 70 of patients develop dyspnea preterminally. However many months usually pass between the diagnosis of cancer and the occurrence of these complications and during this period the patient is severely affected by the possibility of death. The path of unsuccessful cancer treatment usually occurs in three phases. First there is optimism at the hope of cure when the tumor recurs there is the acknowledgment of an incurable disease and the goal of palliative therapy is embraced in the hope of being able to live with disease finally at the disclosure of imminent death another adjustment in outlook takes place. The patient imagines the worst in preparation for the end of life and may go through stages of adjustment to the diagnosis. These stages include denial isolation anger bargaining depression acceptance and hope. Of course patients do not all progress through all the stages or proceed through them in the same order or at the same rate. Nevertheless developing an understanding of how the patient has been affected by the diagnosis and is coping with it is an important goal of patient management. It is best to speak frankly with the patient and the family regarding the likely course of disease. These discussions can be difficult for the physician as well as for the patient and family. The critical features of the interaction are to reassure the patient and family that everything that can be done to provide comfort will be done. They will not be abandoned. Many patients prefer to be cared for in their homes or in a hospice setting rather than a hospital. The American College of Physicians has .